Provider Demographics
NPI:1629154539
Name:PARKHURST, MARK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:PARKHURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-402-2379
Mailing Address - Fax:410-469-3085
Practice Address - Street 1:3110 GRACEFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1820
Practice Address - Country:US
Practice Address - Phone:301-572-8340
Practice Address - Fax:301-572-8403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0024093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0943SE-345660-05OtherCAREFIRST BCBS OF MD
MD008203102Medicaid
MD345660-04OtherBCBS
345660-04OtherBCBS-MD
04-13565OtherEVERCARE
52-2096682OtherTRICARE NORTH
0055OtherCAREFIRST BCBS
MD156221500Medicaid
9680-0031OtherCAREFIRST BCBS OF DC
0943ER-345660-05OtherCAREFIRST BCBS OF MD
B93432Medicare UPIN
MD008203102Medicaid
020355S32Medicare PIN